Provider Demographics
NPI:1962642355
Name:HUDSON, DEBRA L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:HUDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7610 N STEMMONS FWY STE 600
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4228
Mailing Address - Country:US
Mailing Address - Phone:214-689-5960
Mailing Address - Fax:469-713-8084
Practice Address - Street 1:3242 PRESTON RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3311
Practice Address - Country:US
Practice Address - Phone:972-867-0019
Practice Address - Fax:972-867-7785
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX372090601Medicaid
KY7100235330 (KOHMG)Medicaid
KYP01585068 RR (KOHMG)Medicare PIN